A clue towards improving the European Society of Medical Oncology risk group classification in apparent early stage endometrial cancer? Impact of lymphovascular space invasion

Abstract

Background:Lymphovascular space invasion (LVSI) is one of the most important predictors of nodal involvement and recurrence in early stage endometrial cancer (EC). Despite its demonstrated prognostic value, LVSI has not been incorporated into the European Society of Medical Oncology (ESMO) classification. The aim of this prospective multicentre database study is to investigate whether it may improve the accuracy of the ESMO classification in predicting the recurrence risk.Methods:Data of 496 patients with apparent early-stage EC who received primary surgical treatment between January 2001 and December 2012 were abstracted from prospective multicentre database. A modified ESMO classification including six risk groups was created after inclusion of the LVSI status in the ESMO classification. The primary end point was the recurrence accuracy comparison between the ESMO and the modified ESMO classifications with respect to the area under the receiver operating characteristic curve (AUC).Results:The recurrence rate in the whole population was 16.1%. The median follow-up and recurrence time were 31 (range: 1–152) and 27 (range: 1–134) months, respectively. Considering the ESMO modified classification, the recurrence rates were 8.2% (8 out of 98), 23.1% (15 out of 65), 25.9% (15 out of 58), and 45.1% (28 out of 62) for intermediate risk/LVSI−, intermediate risk/LVSI+, high risk/LVSI−, and high risk/LVSI+, respectively (P<0.001). In the low risk group, LVSI status was not discriminant as only 7.0% (14 out of 213) had LVSI+. The staging accuracy according to AUC criteria for ESMO and ESMO modified classifications were of 0.71 (95% CI: 0.68–0.74) and 0.74 (95% CI: 0.71–0.77), respectively.Conclusions:The current modified classification could be helpful to better define indications for nodal staging and adjuvant therapy, especially for patients with intermediate risk EC.

Prognostic significance of lymphovascular space invasion in low-risk endometrial cancer

“…However, Briet et al13 suggested that lymphovascular space invasion itself may individually be used to assign stage I low-risk patients to adjuvant therapy in order to decrease the failure rate and thereby improve the survival. Additionally, the European Society for Medical Oncology-modified criteria35 has recently introduced lymphovascular space invasion as the cornerstone of risk stratification in endometrioid endometrial cancer. Regardless of myometrial invasion, the European Society for Medical Oncology-modified criteria recommends adjuvant treatment for all grade 1 or 2 endometrioid type tumors if lymphovascular space invasion is unequivocally positive.…”

Identification of microRNA expression profile related to lymph node status in women with early-stage grade 1–2 endometrial cancer

“…In this specific setting, many centers in the United States perform lymph node sampling, 5,6 rates that can be higher in the case of lymphovascular space involvement (LVSI) on the primary tumor. [7][8][9] It is now well established that conventional methods used for histologic classification and grading of EC are not sufficient to predict lymph node metastases. This is probably due to considerable heterogeneity within endometrioid histologic subtypes.…”

Nestin: A Biomarker of Aggressive Uterine Cancers

“…Most uterine cancers have a favorable prognosis and are cured by surgery alone. Identifying patients at risk of recurrence, particularly those misclassified as low risk by current clinicopathologic standards [3][4][5][6][7][8][9] is of paramount importance. Physicians need better risk stratification tools to identify when and which adjuvant therapy will decrease recurrence.…”